早期の後極分解と心臓不整脈

早期の後極分解（EAD）は、長いQT症候群と心不全における致死心室不整脈の重要な原因ですが、細胞スケールでのEADが多型心室頻脈（PVT）やトルサドDEポイント（TDP）などの不整脈を引き起こします。ここでは、この分野の最近の進歩を要約して、（1）EADSのイオン基礎について議論します。PVTおよびTDPの根底にあるリエントラント心室性不整脈、および（5）治療上の意味。

Early afterdepolarizations (EADs) are an important cause of lethal ventricular arrhythmias in long QT syndromes and heart failure, but the mechanisms by which EADs at the cellular scale cause arrhythmias such as polymorphic ventricular tachycardia (PVT) and torsades de pointes (TdP) at the tissue scale are not well understood. Here we summarize recent progress in this area, discussing (1) the ionic basis of EADs, (2) evidence that deterministic chaos underlies the irregular behavior of EADs, (3) mechanisms by which chaotic EADs synchronize in large numbers of coupled cells in tissue to overcome source-sink mismatches, (4) how this synchronization process allows EADs to initiate triggers and generate mixed focal reentrant ventricular arrhythmias underlying PVT and TdP, and (5) therapeutic implications.